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Patient age and duration of colonoscopy are predictors for adenoma detection in both proximal and distal colon

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World Journal of Gastroenterology 2015年第2期21卷 525-532页

作者： Peter Klare Stefan Ascher Alexander Hapfelmeier Petra Wolf Analena Beitz roland m Schmid Stefan von Delius Ⅱ.medizinische Klinik Klinikum rechts der IsarTechnischen Universit?t München81675 MunichGermany institut für medizinische Statistik und Epidemiologie Klinikum rechts der IsarTechnische Universit?t München81675 MunichGermany

AIm: To investigate the relation of patient characteristics and procedural parameters to the endoscopic detection rate of colonic adenomas. further to study,which factors may be capable to predict the localization of adenomatous ***: We used the data base of a prospective randomized colonoscopy study(The Colo Cap trial) to identify patients being diagnosed with colon adenoma. Logistic regression analysis was conducted to reveal predictors for adenoma detection in the entire colon and also with respect to the proximal and distal part. Covariates including age, gender, duration of colonoscopy and comorbidities were defined to determine association between predictors and adenoma ***: Equal numbers of adenomas were detected in the proximal and distal side of the splenic flexure [126(57%) vs 94(43%), P = 0.104]. Simultaneous occurrence of adenomas in both sides of the colon was rare. The appearance of both proximal and distal adenoma was associated with increasing age(P = 0.008 and P = 0.024) and increasing duration of colonoscopy(P male gender was a predictor for adenoma detection in the proximal colon(P = 0.008) but statistical significance was slightly missed with respect to the distal colon(P = 0.089). Alcohol abuse was found to be a predictor for the detection of distal adenoma(P = 0.041). CONCLUSION: Increasing age and longer duration of colonoscopy are factors with a strong impact on adenoma detection both in the proximal and distal colon. Since proximal adenomas occurred in absence of distal adenomas, complete colonoscopy should be performed for screening.

关键词： Adenoma Colorectal carcinoma Distal Colonoscopy Pr

New aspects in the pathomechanism and diagnosis of the laryngopharyngeal reflux-clinical impact of laryngeal proton pumps and pharyngeal p H metry in extraesophageal gastroesophageal reflux disease

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World Journal of Gastroenterology 2015年第3期21卷 982-987页

作者： Valentin Becker romina Drabner Simone Graf Christoph Schlag Simon Nennstiel Anna maria Buchberger roland m Schmid Dieter Saur monther Bajbouj Ⅱ.medizinische Klinik Klinikum rechts der IsarTechnische Universit?t München81675 MünchenGermany Hals-Nasen Ohren Klinik Klinikum rechts der IsarTechnische Universit?t München81675 MünchenGermany

AIm:To determine the laryngeal H+K+-ATPase and pharyngeal p H in patients with laryngopharyngeal reflux(LPr)-symptoms as well as to assess the symptom scores during PPI ***:Endoscopy was performed to exclude neoplasia and to collect biopsies from the posterior cricoid area(immunohistochemistry and PCr analysis).Immunohistochemical staining was performed with monoclonal mouse antibodies against human H+K+-*** real-time rT-PCr for each of the H+K+-ATPase subunits was *** p H values were assessed in the aerosolized environment of the oropharynx(Dxp H Catheter) and compared to a subsequently applied combined p H/mII ***:Twenty patients with LPr symptoms were *** only one patient,the laryngeal H+K+-ATPase was verified by immunohistochemical *** another patient,real-time rT-PCr for each H+K+-ATPase subunit was *** out of twenty patients had pathological results in Dxp H,and 6/20 patients had pathological results in p H/*** patients had pathological results in both functional *** out of twenty patients responded to ***:The laryngeal H+K+-ATPase can only be sporadically detected in patients with LPr symptoms and is unlikely to cause the LPr *** hypotheses for the pathomechanism are *** role of pharyngeal p H-metry remains unclearand its use can only be recommended for patients in a research study setting.

关键词： Laryngopharyngeal reflux Proton pump inhibitor Gas

Update on surgical treatment of pancreatic neuroendocrine neoplasms

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World Journal of Gastroenterology 2014年第38期20卷 13893-13898页

作者： Jan G D’Haese Chiara Tosolini Güralp O Ceyhan Bo Kong Irene Esposito Christoph W michalski J?rg Kleeff Department of Surgery Klinikum rechts der IsarTechnische Universit?t München institute of Pathology Technische Universit?t München

Pancreatic neuroendocrine neoplasms(PNENs) are rare and account for only 2%-4% of all pancreatic neoplasms. All PNENs are potential(neurendocrine tumors PNETs) or overt(neuroendocrine carcinomas PNECs) malignant,but a subset of PNETs is low-risk. Even in case of low-risk PNETs surgical resection is frequently required to treat hormone-related symptoms and to obtain an appropriate pathological diagnosis. Low-risk PNETs in the body and the tail are ideal for minimallyinvasive approaches which should be tailored to the individual patient. Generally,surgeons must aim for parenchyma sparing in these cases. In high-risk and malignant PNENs,indications for tumor resection are much wider than for pancreatic adenocarcinoma,in many cases due to the relatively benign tumor biology. Thus,patients with locally advanced and metastatic PNETs may benefit from extensive resection. In experienced hands,even multi-organ resections are accomplished with acceptable perioperative morbidity and mortality rates and are associated with excellent long term survival. However,poorly differentiated neoplasms with high proliferation rates are associated with a dismal prognosis and may frequently only be treated with chemotherapy. The evidence on surgical treatment of PNENs stems from reviews of mostly singlecenter series and some analyses of nation-wide tumor registries. No randomized trial has been performed to compare surgical and non-surgical therapies in potentially resectable PNEN. Though such a trial would principally be desirable,ethical considerations and the heterogeneity of PNENs preclude realization of such a study. In the current review,we summarize recent advances in the surgical treatment of PNENs.

关键词： Surgery Laparoscopy Liver metastases Pancreatic neuroendocrine neoplasms Pancreatic neuroendocrine neoplasm

Cerebral venous sinus thrombosis after ChAdOx1 nCov- 19 vaccination with a misleading first cerebral mrI scan

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Stroke & Vascular Neurology 2021年第4期6卷 668-670页

作者： Benno Ikenberg Antonia franziska Demleitner Thomas Thiele Benedikt Wiestler Katharina Götze Georg mößmer Paul Lingor Department of Neurology Klinikum rechts der Isar der Technischen Universität MünchenMunchenGermany institut für Immunologie und Transfusionsmedizin Universitätsmedizin GreifswaldGreifswaldGermany Department of Diagnostic und Interventional Neuroradiology Klinikum rechts der Isar der Technischen Universität MünchenMunchenGermany Department of medicine III Klinikum rechts der Isar der Technischen Universität MünchenMunchenGermany institute for Clinical Chemistry and Pathobiochemistry Klinikum rechts der Isar der Technischen Universität MünchenMunchenGermany

SUmmArY Vaccine-induced immune thrombotic thrombocytopenia(VITT)and cerebral venous sinus thrombosis(CVST)have been recently described as rare complications following vaccination against SArS-CoV-2 with vector *** report a case of a young woman who presented with VITT and cerebral CVST 7 days following vaccination with ChAdOx1 nCov-19(AstraZeneca).While the initial mrI was considered void of pathological findings,mrI 3 days later revealed extensive CVST of the transversal and sigmoidal sinus with intracerebral *** tests including a platelet-factor-4-induced platelet activation assay confirmed the diagnosis of *** with intravenous immunoglobulins and argatroban resulted in a normalisation of platelet counts and remission of CVST.

关键词： vaccination cerebral venous

Treatment of eosinophlic esophagitis with swallowed topical corticosteroids

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World Journal of Gastroenterology 2020年第36期26卷 5395-5407页

作者： Simon Nennstiel Christoph Schlag klinikum rechts der isar der technischen Universität münchen Klinik und Poliklinik für Innere Medizin IIMunich 81675Germany

Eosinophilic esophagitis(EoE)is an emerging chronic local immune-mediated disease of the *** proton pump inhibitors and food-restrictiondiets swallowed topical corticosteroids(STC)can be offered as a first line therapy according to current *** review describes the background and practical management of STCs in *** far,mainly asthma inhalers containing either budesonide or fluticasone have been administered to the esophagus by swallowing these medications“off label”.recently esophagus-targeted formulations of topical steroids have been developed showing clinicopathological response rates up to 85%-an orodispersible tablet of budesonide has been approved as the first“in label”medication for EoE in Europe in June *** it was shown that disease remission induction of EoE by STCs is highly effective,there is still a lack of data regarding long-term and maintenance ***,current studies on STC maintenance therapy add some movement into the game.

关键词： Eosinophilic esophagitis Swallowed topical corticosteroids Esophagustargeted formulations of topical steroids fluticasone Budesonide Budesonide orodispersible tablet Budesonide oral suspension

Lactate-avid regulatory T cells:metabolic plasticity controls immunosuppression in tumour microenvironment

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Signal Transduction and Targeted Therapy 2021年第5期6卷 1418-1419页

作者： Gabriele multhoff Peter Vaupel radiation Immuno-Oncology Project Group TranslaTUM–Central Institute for Translational Cancer ResearchKlinikum rechts der IsarTU MünchenMunichGermany Department of radiation Oncology Klinikum rechts der IsarTU MünchenMunichGermany Department of radiooncology and radiotherapy Tumour Pathophysiology GroupUniversity Medical Centre MainzMainzGermany

The excellent article by Watson et al.1 points the way ahead to the important role of lactic acid/lactate-anion and glucose on the immunosuppressive activity of lactate-and glucose-affine metabolically distinct subset... 详细信息

关键词： tumour al. microenvironment

Endoscopic stent therapy in patients with chronic pancreatitis:A 5-year follow-up study

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World Journal of Gastroenterology 2013年第5期19卷 715-720页

作者： Andreas Weber Jochen Schneider Bruno Neu Alexander meining Peter Born Stefan von Delius monther Bajbouj roland m Schmid Hana Algül Christian Prinz II medizinische Klinik und Poliklinik Klinikum Rechts der IsarTechnische Universitt München81675 MünchenGermany II medizinische Klinik Gastroenterologie und HepatologieHelios Klinikum WuppertalUniversitt Witten/Herdecke42283 WuppertalGermany

AIm:This study analyzed clinical long-term outcomes after endoscopic therapy,including the incidence and treatment of relapse. mETHODS:This study included 19 consecutive patients(12 male,7 female,median age 54 years)with obstructive chronic pancreatitis who were admitted to the 2nd medical Department of the Technical University of *** patients presented severe chronic pancreatitis(stageⅢ°)according to the Cambridge *** majority of the patients suffered intermittent pain attacks.6 of 19 patients had strictures of the pancreatic duct;13 of 19 patients had strictures and *** first endoscopic retrograde pancreatography(ErP)included an endoscopic sphincterotomy, dilatation of the pancreatic duct,and stent *** first control ErP was performed 4 wk after the initial intervention,and the subsequent control ErP was performed after 3 mo to re-evaluate the clinical and morphological *** follow-up was performed annually to document the course of pain and the management of *** course of pain was assessed by a pain scale from 0 to *** date and choice of the therapeutic procedure were documented in case of relapse. rESULTS:Initial endoscopic intervention was successfully completed in 17 of 19 *** 17 patients reported partial or complete pain relief after endoscopic *** therapy failed in 2 patients. Both patients were excluded from further *** failed patient underwent surgery,and the other patient was treated conservatively with pain *** of 19 patients were followed after the successful completion of endoscopic stent *** of 17 patients were lost to *** patient was not avail-able for interviews after the 1st year of *** patients died during the 3rd year of *** both patients chronic pancreatitis was excluded as the cause of *** patient died of myocardial infarction, and one patient succumbed to *** three patient

关键词： Chronic pancreatitis Pain Stent therapy Endoscopic retrograde cholangiopancreatography Pancreaticolithiasis

Irritable bowel syndrome: relations with functional, mental, and somatoform disorders

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World Journal of Gastroenterology 2014年第20期20卷 6024-6030页

作者： Constanze Hausteiner-Wiehle Peter Henningsen Psychosomatic Consultation Service Murnau Trauma Center 82418 Murnau Germany Department of Psychosomatic medicine and Psychotherapy Klinikum rechts der Isar Technische Universit?t München 81675 Munich Germany

This review describes the conceptual and clinical relations between irritable bowel syndrome (IBS), other functional, somatoform, and mental disorders, and points to appropriate future conceptualizations. IBS is considered to be a functional somatic syndrome (fSS) with a considerable symptom overlap with other fSSs like chronic fatigue syndrome or fibromyalgia syndrome. IBS patients show an increased prevalence of psychiatric symptoms and disorders, especially depression and anxiety. IBS is largely congruent with the concepts of somatoform and somatic symptom disorders. roughly 50% of IBS patients complain of gastrointestinal symptoms only and have no psychiatric comorbidity. IBS concepts, treatment approaches, as well as health care structures should acknowledge its variability and multidimensionality by: (1) awareness of additional extraintestinal and psychobehavioral symptoms in patients with IBS; (2) general and collaborative care rather than specialist and separated care; and (3) implementation of “interface disorders” to abandon the dualistic classification of purely organic or purely mental disorders.

关键词： functional somatic syndrome Somatoform disorder Somatic symptom disorder Bodily distress syndrome Interface Irritable bowel syndrome

Asymptomatic pancreatic lesions: New insights and clinical implications

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World Journal of Gastroenterology 2012年第33期18卷 4474-4477页

作者： martin Loos Christoph W michalski Jrg Kleeff Department of Surgery Klinikum rechts der Isar Technische Universitt München 81675 München Germany

Despite great efforts in experimental and clinical research, the prognosis of pancreatic cancer (PC) has not changed significantly for decades. Detection of pre-invasive lesions or early-stage PC with small resectable cancers in asymptomatic individuals remains one of the most promising approaches to substantially improve the overall outcome of PC. Therefore, screening programs have been proposed to identify curable lesions especially in individuals with a familial or genetic predisposition for PC. In this regard, Canto et al recently contributed an important article comparing computed tomography, magnetic resonance imaging, and endoscopic ultrasound for the screening of 216 asymptomatic high-risk individuals (HrI). Pancreatic lesions were detected in 92 of 216 asymptomatic HrI (42.6%). The high diagnostic yield in this study raises several questions that need to be answered of which two will be discussed in detail in this commentary: first: which imaging test should be performed? Second and most importantly: what are we doing with incidentally detected pancreatic lesions? Which ones can be observed and which ones need to be resected?

关键词： Pancreatic cancer Early-stage pancreatic cancer Asymptomatic high-risk individuals Preinvasive pancreatic lesions Cystic pancreatic tumors Screening Computed tomography magnetic resonance imaging Endoscopic ultrasound